Provider Demographics
NPI:1659337426
Name:MANN, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:MANN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1635 DIVISADERO ST.
Mailing Address - Street 2:STE 625, BOX 1821
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0001
Mailing Address - Country:US
Mailing Address - Phone:415-476-4029
Mailing Address - Fax:415-476-4150
Practice Address - Street 1:500 PARNASSUS AVE STE MU423
Practice Address - Street 2:BOX 0118
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2203
Practice Address - Country:US
Practice Address - Phone:415-353-1660
Practice Address - Fax:415-353-1312
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG74962208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G749620Medicaid
CA00G749620Medicare PIN
CAF65707Medicare UPIN